King Lauryn, Strasser Julia, Luckenbill Sara, Schenk Ellen, Tsevat Danielle, Maslowsky Julie
GW Institute of Public Policy, The George Washington University, Washington, District of Columbia.
Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia.
Womens Health Issues. 2025 Jul-Aug;35(4):245-252. doi: 10.1016/j.whi.2025.04.001. Epub 2025 May 22.
Adolescents and young adults (AYAs) face unique barriers to contraceptive care that may be exacerbated by the June 2022 Dobbs v. Jackson Women's Health Organization decision that removed federal protections for abortion rights. We examined AYA perspectives on contraception and measured changes in AYA contraceptive use pre- and post-Dobbs.
This study used a mixed-methods design. We analyzed qualitative data from the MyVoice project, an SMS-based survey among AYAs ages 14-24 in the United States. The research team analyzed open-ended responses to questions about the influence of changes to abortion access on AYA contraceptive decision making. We analyzed quantitative data from the IQVIA Longitudinal Pharmacy and Medical Claims data for patients ages 15-26. We identified monthly new contraceptive prescriptions and services for intrauterine device insertion and implant placement in 2021 and 2022. We used segmented regression analyses to test for changes in prescriptions and services post-Dobbs.
Our qualitative analysis identified themes of risk aversion, urgency and fear, and access concerns in response to the Dobbs decision. Our quantitative analysis demonstrated a slight increase in both prescriptions and services in the months immediately after Dobbs, but there were no significant changes in the slope for monthly services post-Dobbs for any age group or method type. We also identified an overall decreasing trend for all age groups and all method types during the full study period of January 2021-December 2022.
Limited changes in contraceptive use despite AYA expressions of fear, feelings of lost agency, and concerns over access may reflect continued (or worsened) barriers to contraceptive access post-Dobbs.
青少年及青年成年人（AYA）在获得避孕护理方面面临独特障碍，2022年6月的多布斯诉杰克逊妇女健康组织案裁决取消了联邦对堕胎权的保护，这可能会加剧这些障碍。我们研究了AYA对避孕的看法，并衡量了多布斯案前后AYA避孕措施使用情况的变化。
本研究采用混合方法设计。我们分析了来自“我的声音”项目的定性数据，该项目是一项针对美国14 - 24岁AYA的基于短信的调查。研究团队分析了关于堕胎权变化对AYA避孕决策影响问题的开放式回答。我们分析了IQVIA纵向药房和医疗索赔数据中15 - 26岁患者的定量数据。我们确定了2021年和2022年每月新的避孕处方以及宫内节育器插入和植入服务的情况。我们使用分段回归分析来测试多布斯案后处方和服务的变化。
我们的定性分析确定了风险规避、紧迫性和恐惧以及对获取途径的担忧等主题，这些都是对多布斯案裁决的回应。我们的定量分析表明，在多布斯案后的几个月里，处方和服务都略有增加，但对于任何年龄组或方法类型，多布斯案后每月服务的斜率没有显著变化。我们还发现，在2021年1月至2022年12月的整个研究期间，所有年龄组和所有方法类型都呈现出总体下降趋势。
尽管AYA表达了恐惧、自主权丧失的感觉以及对获取途径的担忧，但避孕措施使用的变化有限，这可能反映出多布斯案后避孕获取方面持续存在（或恶化）的障碍。
